December 11, 2013

Higher deductibles can, in certain contexts, be useful for introducing some price sensitivity into the system. But that depends on how people go about dealing with them. There are two deep-rooted problems with what remains in many ways an excellent health care system overall: it is too expensive, and not enough people have enough access to it. The cheaper health care becomes, the easier it is to expand access. In a cheaper system, fewer people need subsidies and the subsidies they do need are smaller. Without fixing costs, on the other hand, more and more people, not to mention the government, struggle to pay for our system, and the resources for expanding access shrink as the cost of do so grows.

Unfortunately, the Affordable Care Act puts most of its effort on the wrong end of the problem: access rather than price. That’s one reason the rollout has been going so poorly and in some respects will get worse. Because not much effort was put into cost control, many insurers have taken the one easy step available to them to limit rate shock: restricting provider networks. As a result, people are unexpectedly losing access to doctors they have seen for years.